FROM PEDIATRICS

An interactive level 2 screening test for autism spectrum disorders in toddlers takes only 5-10 minutes to administer, providing an option that might improve early identification of the developmental condition, a new study suggests.

Dr. Roula N. Choueiri of University of Massachusetts Memorial Children’s Medical Center in Worcester, and of Sheldon H. Wagner, Ph.D., of the Behavioral Development and Educational Services in New Bedford, Mass., said the Rapid Interactive Screening Test for Autism in Toddlers (RITA-T) “could greatly expand the availability of effective level 2 ASD screening measures, which would lead to earlier diagnosis of ASD and access to treatment” (J Pediatr. 2015 Aug;167(2):460-466 doi:10.1016/j.jpeds.2015.05.029 ).

“There is an important need for a psychometrically valid and interactive level 2 ASD screening test that is both easily learned and readily administered by clinicians in busy clinical settings and early-intervention programs,” the authors wrote. Training to administer and score their RITA-T requires about 3 hours in small groups, and the authors plan for the tool to exist in the public domain once further validated.

Because level 1 screenings, such as the Modified Checklist for Autism in Toddlers ( M-CHAT ) have high false-positive rates, level 2 assessments can confirm risk of ASD when doctors screen toddlers between 18 and 24 months old. The two existing level 2 screening tests include the Systematic Observation for Red Flags ( SORF ), which requires videotaping, and the Screening Tool for Autism in Two-Year-Olds ( STAT ), which requires 20 minutes to administer.

The RITA-T involves nine interactive activities aimed at assessing toddlers’ joint attention, social awareness, reaction to emotions, awareness of human agency, and several basic cognitive skills. Each activity assigns points for a child’s behaving differently than expected, for a total possible high score of 30, indicating the most atypical development.

For the 61 toddlers, aged 18-36 months, assessed in the study, the average RITA-T score for the 23 children with autism spectrum disorders was 20.8, compared with a score of 13 for the 19 children with non–ASD developmental delays and a score of 10.6 for the 19 typically developing children (P less than .0001). Parents of all these children filled out the M-CHAT, and clinicians administered the Autism Diagnostic Observation Schedule–Generic ( ADOS-G ) to those children identified as higher risk.

The RITA-T scores positively correlated both with the ADOS-G (r = 0.79; P less than .001) and with clinical diagnoses of the condition using the DSM-IV and DSM-5 criteria (r = 0.78 and r = 0.76, respectively; P less than .0001). Using a RITA-T cutoff score of 15 and higher and based on DSM-5 criteria, the tool’s sensitivity was 1.00, and its specificity was 0.84. Within a high-risk group of children, the positive predictive value of RITA-T was 0.88.

The research was supported by the CVS charitable fund, the Susan Saltonstall Pediatric Department, and the Tufts Clinical and Translational Sciences Institute. The authors reported no disclosures.

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